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Tad Bartimus: Rat Lungworm Disease Threatens Tiny Hana

HANA – Nobody arriving at a hastily called community briefing about Hana’s rat lungworm outbreak was drifting in on “local time” Thursday night. By 5:30 p.m., vehicles were parked far up the hill beyond Hana Bay’s Helene Hall, its porch was crowded with latecomers, and every seat inside was taken.

Feeling like “it’s déjà vu all over again,” a farmer observed “there are more people here than at most funerals, and they aren’t even serving food.”

Supper would be late for more than 200 residents who stayed two hours through a half-dozen speakers.

Most folks came straight from work to hear state officials and family members of rat lungworm victims warn of still another health threat to the isolated East Maui community. Barely a decade ago Hana’s 1,200 residents weathered a dengue fever outbreak, and constantly guard against health threats such as typhus caused by flea and tick bites and water-borne leptospirosis.

Kay Howe, a Big Island resident whose son suffers with the consequences of rat lungworm disease, and state health official Dr. Lorrin Pang of Maui address last week’s community meeting in Hana.

Dean Wariner

Hana’s elected officials – Sen. Kalani English, Rep. Lynn DeCoite, and Councilman Robert Carroll – were absent. The crowd was a cross-section of the community and included several teachers, an EMT, a Maui Fire Department battalion chief, the chef and the manager of Hotel Travaasa-Hana, a Hana Ranch administrator, flower and food farmers, a practicing doctor and a physician’s assistant, two nurses, fishermen, carpenters, a wedding photographer, a realtor, a caterer, public works employees, a millionaire or two, caregivers, B&B owners, housekeepers, traveling millennials working in Hana during a gap year, some artists and retirees.

Most know the two residents who are suffering from rat lungworm disease and said they were anxious to protect their own family’s health and safety, livelihood and lifestyle. They were especially worried about consuming locally sourced fruits and vegetables, including those sold at the popular Hana Fresh produce stand, the commercial garden at Hana Health, the town’s private nonprofit medical clinic. A Hana Fresh garden supervisor and several clinic employees attended the meeting.

Dr. Lorrin Pang, the state’s Maui district health director, opened the meeting with an overview of rat lungworm disease. He confirmed that the lethal semi-slugs that carry the disease are on Maui and proliferating in the Hana district. Semi-slugs are far more likely to be carriers — about 80 out of 100 test positive for the disease – than common slugs and snails.

“That’s why this disease is at a hot high rate,” he said. “The semi-slug has a residual shell on its back, it oozes something that looks like pus and has a yellow tint. It’s the grossest thing I’ve ever seen.”

“If you get a whopping dose (of its larvae) you will get a lot of worms wandering around in your brain,” Pang added, snapping the crowd to attention. “You can see the slug, but you are not going to see the germ at the stage that it infects us.”

Dr. Lorrin Pang confirmed that the lethal semi-slugs that carry the disease are on Maui and proliferating in the Hana district.

Six cases have been reported on Maui in the past two months, a number Pang believes is very conservative.

He spoke briefly about the disease’s symptoms of fever, headache, stiff neck, stomach pain and extreme skin sensitivity. He repeatedly stressed that education is the key to safe handling and consumption of fresh produce, freshwater prawns and crabs, and working in gardens and on farms.

A representative of the state’s school gardens program shared a handbook for kids illustrating how they can protect themselves while still having fun growing food, an reassured parents that Hana School’s garden already practices pest control.

Lynn Nakamura-Tengan, a specialist from the state’s agriculture extension service who works with growers, reiterated protective guidelines against slug and snail diseases that farmers should follow.

Nakamura-Tengan opened her presentation by asking: “How many of you wash bananas before you eat them?”

A smattering of hands went up.

“How many of you wash a pineapple before you peel and eat it?”

Fewer hands were raised.

The paltry response was bad news to Nakamura-Tengan. Clearly, the audience had flunked her safe fruits and veggies test.

“Use your hands under clear running tap water to scrub all fresh produce until it looks clean, then scrub it some more! Keep washing and scrubbing until you are absolutely certain all parts are clean.”

Kay Howe, a Big Island resident and graduate student in the Tropical Conservation Biology and Environmental Science program at the University of Hawaii-Hilo, became involved in rat lungworm research after her son, Graham McCumber, contracted the disease and went into a coma in 2008. Her harrowing personal story as well as her bullet-point professional presentation landed a powerful one-two punch.

“My son suffered severe brain damage and I have been working with him the last eight years to help him recover,” Howe said. “I was a teacher at Waimea and had never heard of this disease before. I am sorry (it) has hit your community … I don’t want Hana to go through this like we did.”

With two of their neighbors afflicted with rat lungworm disease, Hana residents packed a community meeting last week to hear health professionals discuss what can be done to protect people from getting sick with the potentially lethal illness.

Dean Wariner

Howe and Susan Jarvi, professor of pharmaceutical sciences at UH-Hilo, formed the Hawaii Island Rat Lungworm Working Group and are continuing to do research and gather data about the disease, its victims and its impact on the Big Island, especially the Puna area.

“The CDC (Centers for Disease Control) said it is rare, but 16 people on Hawaii Island hit the (rat lungworm) jackpot last year,” Howe said. “Many people will never have the life they had before. My son won’t. He has balance issues, vision issues. Some people have committed suicide because of the pain.”

Retired local physician Chad Meyer, who’s expertise in primary care and tropical medicine was sought by two recent rat lungworm victims in early stages of the illness, urged the Health Department to be faster and more proactive with help for East Maui.

“We need aggressive action to figure out what’s going on and do intervention to keep people safe,” he said, later adding that “the kuleana to fight this disease is going to be on our own community, on Hana people, to take care of ourselves and each other.”

Pang closed the meeting by promising, “I’ll be back.”

When he departed, the piles of government handouts that had covered two long banquet tables were gone, carried away by citizens who were more informed, and worried, than when they came.

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